|
PACK LITHO V
|
Facility
|
OP
|
$11.16
|
|
| Hospital Charge Code |
2720030071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Aetna of VT Commercial |
$10.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$6.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.87
|
| Rate for Payer: Cash Price |
$5.58
|
| Rate for Payer: Cigna Commercial |
$8.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$5.02
|
| Rate for Payer: Multiplan Commercial |
$10.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.49
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$10.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare VA CCN |
$5.02
|
|
|
PACK LITHO V
|
Facility
|
IP
|
$11.16
|
|
| Hospital Charge Code |
2720030071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: Aetna of VT Commercial |
$10.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$8.93
|
| Rate for Payer: Cash Price |
$5.58
|
| Rate for Payer: Cigna Commercial |
$8.93
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.93
|
| Rate for Payer: Multiplan Commercial |
$10.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$10.60
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9821105501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.65
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare VA CCN |
$31.50
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9601105502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
5101105501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$45.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9601105502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of VT Commercial |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.17
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.07
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$22.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare VA CCN |
$14.39
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9601105502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$31.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$31.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$55.65
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.50
|
| Rate for Payer: United Healthcare VA CCN |
$31.50
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9821105501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of VT Commercial |
$65.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$62.71
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.17
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.07
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$22.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare VA CCN |
$14.39
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9601105501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Aetna of VT Commercial |
$117.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$54.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$74.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$105.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$100.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$98.58
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$99.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$55.80
|
| Rate for Payer: Multiplan Commercial |
$115.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.40
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$55.80
|
| Rate for Payer: United Healthcare Commercial |
$117.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.80
|
| Rate for Payer: United Healthcare VA CCN |
$55.80
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9601105501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$116.56 |
| Rate for Payer: Aetna of VT Commercial |
$116.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$111.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$111.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.17
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.07
|
| Rate for Payer: Multiplan Commercial |
$115.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$22.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare VA CCN |
$14.39
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
5101105501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of VT Commercial |
$50.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$14.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$20.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$89.17
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$108.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$108.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$67.07
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$20.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$22.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare VA CCN |
$14.39
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9601105501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Aetna of VT Commercial |
$117.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$105.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$104.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$99.20
|
| Rate for Payer: Cash Price |
$62.00
|
| Rate for Payer: Cigna Commercial |
$99.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$99.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$99.20
|
| Rate for Payer: Multiplan Commercial |
$115.32
|
| Rate for Payer: MVP Health Care of NY Commercial |
$105.40
|
| Rate for Payer: United Healthcare Commercial |
$117.80
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
9821105501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of VT Commercial |
$66.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$56.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$56.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$65.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
|
|
PAIRING/CUTTING BENIGN LES 1
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
5101105501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of VT Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$23.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$48.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$43.74
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$42.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.30
|
| Rate for Payer: Multiplan Commercial |
$50.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$45.90
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.30
|
| Rate for Payer: United Healthcare VA CCN |
$24.30
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
9601105702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$85.11 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna of VT Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.00
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.75
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
5101105701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$136.81 |
| Rate for Payer: Aetna of VT Commercial |
$62.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.90
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$30.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.97
|
| Rate for Payer: Multiplan Commercial |
$62.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare Commercial |
$40.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare VA CCN |
$26.51
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
9601105701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$170.14 |
| Rate for Payer: Aetna of VT Commercial |
$170.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$162.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$162.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.90
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$30.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.97
|
| Rate for Payer: Multiplan Commercial |
$168.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare Commercial |
$40.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare VA CCN |
$26.51
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
5101105701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.59 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna of VT Commercial |
$63.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$49.59
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$49.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$56.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.60
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$53.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$62.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.95
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
9821105701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$85.11 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna of VT Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$85.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$96.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$92.00
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.75
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
9821105701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna of VT Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.42
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare VA CCN |
$51.75
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
9601105701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$133.96 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Aetna of VT Commercial |
$171.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$133.96
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$133.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$153.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$144.80
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$144.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$144.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$144.80
|
| Rate for Payer: Multiplan Commercial |
$168.33
|
| Rate for Payer: MVP Health Care of NY Commercial |
$153.85
|
| Rate for Payer: United Healthcare Commercial |
$171.95
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
5101105701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.67 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna of VT Commercial |
$63.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$60.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$29.67
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$60.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$40.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$56.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$54.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$53.27
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$53.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$53.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$53.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$30.15
|
| Rate for Payer: Multiplan Commercial |
$62.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$56.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$30.15
|
| Rate for Payer: United Healthcare Commercial |
$63.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.15
|
| Rate for Payer: United Healthcare VA CCN |
$30.15
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
9601105702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$136.81 |
| Rate for Payer: Aetna of VT Commercial |
$108.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.90
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$30.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.97
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare Commercial |
$40.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare VA CCN |
$26.51
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
9821105701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$136.81 |
| Rate for Payer: Aetna of VT Commercial |
$108.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$27.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$37.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$111.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$30.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$111.90
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$30.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$136.81
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$136.81
|
| Rate for Payer: Martins Point Health Care Commercial |
$84.97
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.64
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare Commercial |
$40.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.51
|
| Rate for Payer: United Healthcare VA CCN |
$26.51
|
|
|
PAIRING/CUTTING BENIGN LES >4
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
9601105702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna of VT Commercial |
$109.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$103.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$69.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$97.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$93.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$91.42
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$92.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$92.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$106.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$97.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$109.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.75
|
| Rate for Payer: United Healthcare VA CCN |
$51.75
|
|
